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DATE •
TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
WATER DIVISION
The undersigned applies f01'a supply of water at Ko.St.and hereby agrees to
comply with the rules and l'egulations as now,or at.any fu ture time,est.ablished by the Board of Selectm€n.~
Sketch of Senice ReTe
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--'---:-LJ--i-I_:_,_',_'I ,_:_D:;~""I~_'_,--j--'_'_--i--~L~-+-l--,',"I,I I '!l'I I '1 1 1 ,----r +--+-i --j--:-----T--!',---r I-I --+-'+-'L-'---r-I~-'-'-H--~-;-,--:-i-:-++-j--~-c-+-+-'l--t _1_,0,1__,'-:~-,-I'-,i..-.L.L-1',,'-+-1--'--;.-'-r-'----1-,'..L-,--_',--t _~,LI--.J :
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--'--'--'-I ,I _1 ,1_
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Am't.of Estimate 5~_,_
Am·t.Paid S
Buiider _
Connection made in
l(emarks;
Owner
Address
."37 Street.
C0T~
Work completed
,'O~
"'.
19
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